Post op complications Flashcards
Called post-op surgery- ask nurse
waht kind of surgey did patient have and what day postop is it?
post op atelectasis common after
mechanical ventilation
msot common cause of post operative death
pneumonia
if atelectasis goes untreated post-op, can lead to
pneumonia
pna tx
double coverage
pulmonary causes of fever post-op
atelectasis, pna, acute respiratory failure, PE
if patient does not have dysuria but have post op fever, do you still do UA?
YES
UTI can cause post op fever and more commonly occurs with
foley catheters, so early removal or not placing them in first place is best
tx of surgical site infection post -op
superficial- I and D. Deep (intra abdominal abscess)- IR drainage or open debridement (necrosis, would breakdown)
how long can it take for abscess to manifest
7-10 days
patient presents 3 days post op with pyrexia, sweating, chills, cellulitis, dehiscence. suspect
would infection
most common sites for peritoneal abscesses
subphrenic space, subhepatic space. also paracolic gutters, pelvix, periappendical or pericolic areas
common drugs responsible for fever post op
abx, chemo drugs, dilantin,, barbiturates, quinidine, drug that can caues NMS
post op cardiac complications can include
hypotension/hypertension, dysrhythmias, or MI
most common cause of post op HTN
pain
when is ichemica incidence highest
first 48 hours post op
acute oliguria
urine output less than 0.5 ml/kh/hr OR less than 30 ml/hour
low urine output categories
intrinsic or extrinsic (pre renal or post renal)
most common etiology of low urine output
pre-renal disease
pre-renal vs.. post renal disease causes
pre-renal d/t reduced blood volume (external fluid loss from hemomrrhage, dehydration, diarrhea) or (internal fluid loss from pancreatitis, bowel obstruction, third spacing). post renal- d/t obstruction from BPH, stone, tumor
hypotensive, tachycardic, low urine output, think
hemorrhage
low urine output tx
if pre-renal give 500-1000 cc NS or LR over an hour, monitor for volume overload. if post-renal, manage obstruction- bladder scan and foley
lasix and pressors in managing low urine output?
avoid. pressors- unless in septic shock
postop intestinal obstruction can be
mechanical or functional
return of bowel function time frame
small bowel- 24 hours, stomach- 48 hours. large bowel- 72 hours (assuming there was not intestinal surgery or obstruction present)
factors that worsen/prolong post op ileus
narcotics, electrolyte abnormalities, pain, inflammatory conditions
workup if ileus is suspected d/t abscess
CT
workup if concern for mechanical obstruction
SBFT
tx of ileus post op
Time! NPO, IVF, NG decompression ONLY if patient vomits, TPN if ileus lasts more tahn 3-4 days
if pulse rate goes up when BP goes down
hypovolemia
if pulse rate and BP both go down
vasovagal
if you cannot get post op pain controlled, consider..
antra-abdominal disaster, esp if there are lab abnormalities (WBC, LA, lipase)
post op complication of bleeding- what labs to order
CBC, urine output, vital signs
pain control post op
PCA, bolus trick
post op complications possible
post op fever, cardiac complications, low urine output, renal failure, ileus and obstruction, bleeding, post op pain
